Provider Demographics
NPI:1467779546
Name:MCMURRAY, TIMOTHY IVAN (MD)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:IVAN
Last Name:MCMURRAY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 VERONICA CT
Mailing Address - Street 2:
Mailing Address - City:CORRALES
Mailing Address - State:NM
Mailing Address - Zip Code:87048-6925
Mailing Address - Country:US
Mailing Address - Phone:550-881-2967
Mailing Address - Fax:
Practice Address - Street 1:100 JOHN DANTIS RD SW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87151-0100
Practice Address - Country:US
Practice Address - Phone:505-839-8850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-28
Last Update Date:2010-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM90-247207R00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice